Healthcare options in Udaipur

Welcome back for another month, casual reader. As many of you know or can imagine, daily life in Udaipur, Rajasthan, presents endless unforeseen joys and calamities. Speaking of the latter, the event that defined November (month 3 in India) was a scooter crash. Although I had no permanent injury, I suffered second degree degree bruises, a broken ankle, a probable (but undiagnosed) small fracture in my hip, and some nasty scrapes. I am still working diligently on repairing my friendship with the driver, as well as my scooter. I will discuss my ankle injury and the treatment that I received as an informative case study on the healthcare options available in Udaipur. Everything is a learning opportunity if you look at it right!

Before delving into the past month’s events, I will include some other details about the current state of my project and other news the state of my life at the moment. To remind some of you my main project at Seva Mandir is a study of common property resources in select villages of three districts of Rajasthan.

In India, government policy officially promotes community management of forests and pasturelands. At the same time, households have an incentive to try to privatize common lands so that they can graze livestock more intensively. This can deplete the resource completely, as each person seeking his/her own interest blindly over-exploits resources. This is more or less the metaphorical scenario of the “Tragedy of the Commons” posed by ecologist Garrett Hardin in a very famous 1968 paper that you can read here . We now know that people often act with better foresight and create all kinds of arrangements to cooperate, an observation for which Elinor Ostrom became the first female winner of the Nobel Prize in 2009.

OK, is anyone still awake? I’m sorry, but this is one of the hard points in my research…Some of the other fellows’ working in urban areas are writing blogs that leave me on the edge of my seat thinking about the struggle to survive in India’s slums (Marielle and Ré stand out as recent examples-don’t miss their most recent posts.) As one of the Clinton Fellowship orientation speakers said, urban NGOs work in situations where managing immediate crisis is the main task.

At an NGO working on rural issues, responses occur over months and years. However, the chance to really influence systemic changes is huge. Consider, for example, that according to the International Energy Agency (IEA) more than 800 million people in India depend on some amount of traditional biomass fuel (more than 1/3 of the global total of 2.4 billion people using traditional biomass). That’s firewood, cow dung, dry grasses, etc. 800+ million people is in the range of whole population of all the Americas or Africa. Now imagine the poorest people in each village forced to purchase kerosene or sell livestock because relatively wealthy neighbors have taken over village pastureland or forest, bribing local officials to gain title to the land. Such is the story that has made life for India’s rural poor more tenuous, while expanding agriculture and grazing degrade important ecosystems.

So I struggle with these large systematic effects, trying to communicate why it all matters to people outside my project. To make matters more challenging, our project hinges on gaining access to important maps and documents from government agencies, whose transparency and capability I have tried to criticize in a diplomatic way in past blog posts. November presented me a time to gain fuller understanding of the meaning of my research for policy advocacy, NGO collaboration, etc. However, the pauses in the project, along with my injuries, have led me to certain doubts…is this research meaningful if villagers remain so poor for so long after project intervention? Are Gandhian principles and participatory development practical in today’s world? How much of the project will I be able to do in my short 10 months in India? What can I add, and how can I contribute with my experience and skills to Seva Mandir’s work?

This is where my project stands for the moment. I’ll continue my narrative with some photos of the month’s events.

I’m sorry that this one is slightly graphic, but hopefully it’ll serve as a warming to all of you fellows out there who feel invincible on those wild urban motorcycle rides. Accidents do happen! Wear a helmet (I was), even if it’s not Indian cool!

This is the public hospital in Udaipur, which smells strongly of urine and is dank and dirty. The public health facilities available to the poor are sub-standard by any Indian measure. Someone had to purchase gauze for me, even though I came in an ambulance in a state of great pain and moderate shock. Trying to find your wallet, then waiting as you bleed is an embittering experience. The doctor entirely missed the break in my ankle on the x-ray, and orderlies tried to discharge me after half an hour, even though I was still fainting from pain and shock. Three days later, a doctor at a low cost clinic (where someone brought me) called my fracture minor and prescribed a bandage for the swelling. Two and a half weeks later, an orthopedic surgeon at the best hospital in Udaipur told me that the bone had in fact moved since the original diagnosis, which would require surgery to insert a pin. The third diagnosis finally yielded the right treatment, although recovery has been a bit difficult. Moreover, proper treatment will cost well over 30,000 rupees, far beyond what all but the richest class in India could afford to pay.

Near Divali everyone is cleaning and repairing houses for an auspicious cycle of the Hindu calendar. For villagers, this means resurfacing earthen floors, which remain so hard that people can sweep them.

Freshly refinished. Primitive to some, the traditional techniques of constructing and maintaining homes can be far more dignified and sanitary than that of slum dwellers. If the world were simple, then villages would be backwards in every way and cities always an improvement, even considering conditions in the most dire slum. However, people decide to migrate or remain in villages for complex reasons, and villages are heterogeneous.

I avoid taking portrait-style shots out of respect, but I was on this particular field visit without much to do, as Seva Mandir employees were doing surveys about implementation of a program for cleaner burning stoves and solar cookers. The children got interested in my camera, and wanted me to take a lot of photos. This old lady didn’t seem too concerned.

Seeking an escape from Udaipur and the stresses of being injured, I went to Pushkar, located about six hours away, for the Pushkar camel festival. My ankle prevented me from seeing the massive camel-trading ground (which by all accounts looked like a big empty space with thousands of camels). Nevertheless, I enjoyed seeing one of the world’s two Brahma temples with Kishore, who did his Hindu thing while I tried to observe the architecture and not be the foreigner in search of spirituality through someone else’s religion. The bathing ghats here are beautiful in the morning light.

Pious Hindus from all over India pass through Pushkar. From ascetic holy men, or sadhus, to young male waiters not so subtly hitting on foreign women to Rajasthani camel herders, everyone’s on the street. Hoards of foreign tourists eat muesli and buy jewelry, yet the Indian pilgrims just mix indifferently with this crowd. While it’s easy to point out a history of community conflict, identity politics, and other sectarian issue in India, I would argue anecdotally that scenes like this show a tolerance for extreme difference in identity, practice, belief, etc. that is a unique strength of India. The tolerance for chaos and cognitive dissonance is incredible!

Hmm–this monkey’s gaze is contemplative. The presence of and tolerance for urban monkeys is another thing that I think is great about Mother India, even if she’s given me her share of blows in the last month.